Chiropractors make up half the clinical positions in Ontario’s Rapid Access Clinics (RACs) for Low Back Pain (LBP) – a program helping people with low back pain receive faster access to appropriate care.

Interprofessional Spine Assessment and Education Clinics (ISAEC) pilot results, which Ontario’s Rapid Access Clinics (RACs) for Low Back Pain (LBP) are built on.

The Challenge:

  • In a 2019 study, 41 per cent of Ontario respondents reported having low back pain.¹
  • Chronic (long-term) low back pain is estimated to affect 4 to 25 per cent of the population, depending on the case definition, methodology and study sample.²
  • Prior to the RAC for LBP launch, many patients with low back pain were waiting months for imaging tests or to see a surgical specialist, which they often didn’t need.
  • While waiting, these patients often received limited support and guidance about their condition, treatment options or how to manage their pain. And when it finally came, their treatment might include an opioid prescription for any chronic pain, even though there are more appropriate options.

RACs for LBP offer a better way to direct Ontarians with low back pain to appropriate care in a timely manner.

Building on Research and Results

The RAC program for LBP builds on the successful Interprofessional Spine Assessment and Education Clinics (ISAEC) program, piloted from 2012 to 2017, in Toronto, Hamilton and Thunder Bay, for patients who required 6 to 12 weeks of care.³

How a RAC for LBP Works

When a physician or nurse practitioner refers a patient to a RAC for LBP, they first meet with an Advanced Practice Provider (APP), who is an experienced chiropractor, physiotherapist and/or a nurse practitioner, in their community. The APP provides them with:

  • A rapid low back pain assessment
  • Education about their condition
  • An evidence-based plan they can follow to manage it

Patients who need more advanced surgical assessment and management are referred to a RAC Practice Lead, who is usually in a hospital. This Practice Lead can provide a more in-depth assessment, order images, if required, and provide a surgical referral, if needed.

Ontario launched RACs in late 2017 and expanded them across the province.

How RACs for LBP Helps Ontarians

The Ontario government-funded RACs for LBP are designed to:

  • Decrease the prevalence of unmanageable low back pain
  • Reduce unnecessary diagnostic imaging tests and wait times
  • Reduce unnecessary referrals to specialists

How a RAC May Help You

You may be eligible for the RAC for LBP program if you have:

  • Persistent low back pain and/or related symptoms that do not improve 6 weeks to 12 months after they start
  • Unmanageable, recurring low back pain and/or related symptoms that last less than 12 months when they reoccur

If you believe you are eligible for the RAC for LBP program:

  1. Make an appointment with your family physician or nurse practitioner to ask about a referral to a RAC for LBP.
  2. If you’re referred to a RAC for LBP, you’ll meet with a chiropractor, physiotherapist and/or a nurse practitioner within about four weeks from the referral date.
  3. They will assess your condition, provide you with useful information about it and give you an evidence-based plan to you help you best manage your low back pain.

Chiropractors’ Role and Impact

Chiropractors contributed to the ISAEC pilot’s success and are a key part of the RAC for LBP.

  • RACs for LBP employ more than 50 chiropractors who work as Advanced Practice Providers (APPs) – the first and primary point of contact for consulting with referred patients.
  • Chiropractors hold seven out of fourteen RAC for LBP Practice Lead positions to support patients that APPs have identified as requiring more advanced surgical assessment and management.
  • A panel of RAC for LBP practitioners, including surgeons, physicians and other providers from hospitals, selects chiropractors for the program. Each selected chiropractor collaborates with these other health care professionals to develop management plans for their shared patients.

What patients say about RACs for LBP …

“Knowing that I’ve got somebody I can relate to who can come up with a solution that can make me feel better if I have trouble is comforting. He’s got my back.”

Brian Mandelker, RAC patient, Thornhill, ON

“I can’t even put it into words. I am back to my normal mental and emotional state. I still can’t bend over, but I can sit. It is day and night compared to what it was like.”

Lynne Miles, RAC patient, as quoted in the Ottawa Citizen

What physicians say about RACs for LBP …

“It [RACs] has made management of lower back pain easier for my patients and it has made this challenging area of medicine easier for me.”

Physician and former president,, Ontario College of Family Physicians, as quoted in the Toronto Star

Are you an OCA member? Learn how to get involved in the RAC for LBP program

Get Involved

[1] Robinson, S., Sadiq, A., Wadhawan, V. Attitudes of Ontarians Toward Chiropractic Care (PN 10380), Environics Research, June 2019; 7.
[2] Meucci RD, Fassa AG, Faria N.M. Prevalence of chronic low back pain: systematic review. Rev Saude Publica 2015;49.
[3] Centre for Effective Practice (March 31, 2017). Primary Care Low Back Pain Pilot Evaluation: Final Report. Toronto: ON.